BCBSRI Joins Global Capitation Model, Starts 2022 RI Life Index

Blue Cross & Blue Shield of Rhode Island (BCBSRI) has entered into a global capitation agreement in its Medicare Advantage program, according to a press release which HealthPayerIntelligence received by email, and has also launched its fourth RI Life Index, which it releases every year.

The payer has formed a value-based contract with Prospect Health Services of Rhode Island to cover their seniors. The contract ties positive patient outcomes to total compensation increases in a global capitation model.

“At Blue Cross, we are passionate about shifting from the sick care system we have today, to one focused on keeping people healthy,” said Martha Wofford, president and chief executive officer of BCBSRI. “Everyone wins when providers are rewarded for high quality, proactive care – health care costs go down and most importantly patients stay healthier. We’re pleased to be entering into this agreement with Prospect.”

The partners highlighted that care coordination would be a defining feature of the care that Prospect Health Services of Rhode Island delivers for BCBSRI’s nearly 10,000 Medicare Advantage members. 

As part of the model, the accountable care organization (ACO) will enable care coordination between behavioral healthcare specialists, pharmacists, and members’ primary care providers as well as care outside of the clinical setting, such as telehealth and home healthcare.

“As a major provider group in Rhode Island, we consider this agreement fully representative of the future direction of healthcare,” added Steve O’Dell, Prospect Medical Holdings’ president, coordinated regional care. 

“We are pleased that BCBSRI has taken this bold step forward in supporting value over volume and we encourage other health insurers in Rhode Island to join us as well. We have made considerable progress in the past several years because our value-based care team collaborates closely with our patients and primary care physicians. This approach reflects our ongoing commitment to supporting and empowering our providers and patients to work together toward better health outcomes.”

According to the press release, the partners are confident that this model will give BCBSRI Medicare Advantage members more time with their providers.

In addition to this announcement, BCBSRI announced that it has launched its yearly RI Life Index with Brown University School of Public Health.

The index first launched in 2019 with the goal of assessing social determinants of health factors in the state. 

In 2022, the index will address multiple areas of social determinants of health, such as affordable housing, microaggressions and discrimination, and food security. 

The survey will also go out to multilingual communities where English is not as common. To facilitate the multi-lingual aspect of the survey, the payer will partner with four community-based organizations, which helped to conduct surveys in 14 languages the previous year.

The press release stated that the payer leans on the data from the RI Life Index when planning its community and philanthropic spending.

“Survey results from 2019 through 2021 reinforced that Rhode Island residents are keenly aware of the enormous and devastating impacts that systemic racism and inequity in economic stability and access to housing have on the ability to enjoy good health and well-being in our state,” explained Michele Lederberg, executive vice president, chief legal officer, and chief administrative officer at BCBSRI.

In the past, BCBSRI has worked with academics from Brown University to lower senior adverse drug events. The program built a list of safe prescriptions into a provider partner’s EHR to avoid seniors receiving prescriptions for conflicting medications.